MEDICARE: MID OHIO PULMONARY & SLEEP ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0012X	Sleep Medicine (Internal Medicine) Physician
2	207RP1001X	Pulmonary Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043313273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID OHIO PULMONARY & SLEEP ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	2760 AIRPORT DR
Second Line	:	SUITE 120
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2284
Country	:	US
Telephone Number	:	614-586-0668
Fax Number	:	614-586-0669

Provider Business Practice Location Address
First Line	:	2760 AIRPORT DR
Second Line	:	SUITE 120
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2284
Country	:	US
Telephone Number	:	614-586-0668
Fax Number	:	614-586-0669

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DIANNE STANSIFER
Credential	:
Telephone Number	:	614-586-0668

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	10/07/2014

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